EDUCATION - Disability Rights Texas · Web viewAll necessary health-related services, including...

TEXAS HOME AND COMMUNITY-BASED SUPPORTS AND SERVICES

RICHARD LaVALLO, AustinDisability Rights Texas

State Bar of TexasADVANCED GUARDIANSHIP LAW COURSE

April 7, 2017 Houston

CHAPTER 3

EDUCATION

RICHARD A. LAVALLO2222 W. Braker Ln., Austin, TX 78758

(512) 454-4816 Phone (512) 454-3999 Fax

[email protected]

University of Texas at Austin, J.D. with Honors 1983 University of Texas at Austin, M.S.S.W. 1979University of New Mexico, B.A. Degree with Honors 1973

EMPLOYMENT

Legal Director Disability Rights Texas, Austin, Texas3/09 – Present Plans, directs and supervises the provision of legal services throughout

Advocacy, Incorporated.

Senior Attorney Advocacy, Incorporated, Austin, Texas5/00 – 3/09 Represent persons with disabilities in the areas of special education and mental

health. Experience in representing children with disabilities in the foster care system.

Litigation Coordinator Advocacy, Incorporated, Austin, Texas5/97 – 5/00 Assist regional attorneys in all aspects of litigation, including generating and

developing cases for litigation and co-counseling specified cases with regional attorneys.

Associate Walsh, Anderson, Underwood, Schulze & Aldridge, P.C., Austin, Texas3/96 – 4/97 Represented school districts with emphasis on special education and other

community based providers of mental health services.

Senior Attorney Advocacy, Incorporated, Austin, Texas2/91 – 3/96 Represented persons with disabilities in class actions and complex litigation;

state and federal court practice; appellate experience; drafting and monitoring legislation and administrative regulations.

Staff Attorney Advocacy, Incorporated, Austin, Texas1/89 – 9/90 Represented persons with disabilities in administrative and legal proceedings.

Experience in civil commitment hearings, abuse and neglect investigations and in-patient mental health services.

Staff Attorney Legal Aid Society of Central Texas, Austin, Texas9/83 – 1/89 Practiced family law, specialized in defending suits for termination of parental

rights.

HONORS AND ACTIVITIES

Order of Coif, 1983J. Chrys Dougherty Legal Services Award 2007 Fairy Davenport Rutland Award 2009Member, State Bar of Texas Pro Bono Workgroup, 2014 to present; Commissioner, Texas Access to Justice Commission, 2016 to the present

Texas Home and Community-Based Supports and Services Chapter 3

TABLE OF CONTENTS

I. COMMUNITY LIVING AND ASSISTANCE AND SUPPORT SERVICES (CLASS)...................................1A. What services are available?.......................................................................................................................1B. Who can get services?.................................................................................................................................1C. How do I apply for services?.......................................................................................................................1

II. HOME AND COMMUNITY-BASED SERVICES (HCS)................................................................................1A. What services are provided?........................................................................................................................2B. Who can get services?.................................................................................................................................2C. How do I apply for services?.......................................................................................................................2

III. TEXAS HOME LIVING.....................................................................................................................................2A. What services are available?.......................................................................................................................2B. Who can get services?.................................................................................................................................2C. How do I apply for services?.......................................................................................................................3

IV. DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD)...........................................................................3A. What services are provided?........................................................................................................................3B. Who can get services?.................................................................................................................................3C. Where can I get services?............................................................................................................................3D. How do I apply for services?.......................................................................................................................3

V. MEDICALLY DEPENDENT CHILDREN PROGRAM (MDCP).....................................................................3A. What services are provided?........................................................................................................................4B. Who can get services?.................................................................................................................................4C. How do I apply for services?.......................................................................................................................4

VI. STAR+PLUS WAIVER......................................................................................................................................4A. Who can get services?.................................................................................................................................4B. What services are provided?........................................................................................................................5C. How do I apply for services?.......................................................................................................................5

VII. COMMUNITY FIRST CHOICE........................................................................................................................5A. What is Community First Choice?..............................................................................................................5B. Who can get Community First Choice services?.........................................................................................6C. Community First Choice Services...............................................................................................................6D. Texas began the Community First Choice program on June 1, 2015. This means......................................6

VIII. COMMUNITY ATTENDANT SERVICES.......................................................................................................6A. What services are provided?........................................................................................................................6B. Who can get services?.................................................................................................................................6C. How do I apply for services?.......................................................................................................................6

IX. PRIMARY HOME CARE..................................................................................................................................6A. What services are provided?........................................................................................................................6B. Who can get services?.................................................................................................................................6C. How do I apply for services?.......................................................................................................................7

X. CONSUMER MANAGED PERSONAL ATTENDANT SERVICES...............................................................7A. What services are provided?........................................................................................................................7B. Who can get services?.................................................................................................................................7C. How do I apply for services?.......................................................................................................................7D. Where can I get services?............................................................................................................................7

XI. FAMILY CARE..................................................................................................................................................7A. What services are provided?........................................................................................................................7

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Texas Home and Community-Based Supports and Services Chapter 3B. Who can get services?.................................................................................................................................7C. How do I apply for services?.......................................................................................................................7

XII. HOME-DELIVERED MEALS...........................................................................................................................8A. Who can get services?.................................................................................................................................8B. How do I apply for services?.......................................................................................................................8

XIII. DAY ACTIVITY AND HEALTH SERVICES..................................................................................................8A. What services are provided?........................................................................................................................8B. Who can get services?.................................................................................................................................8C. How do I apply for services?.......................................................................................................................8

XIV. IN-HOME AND FAMILY SUPPORT...............................................................................................................8A. What services are provided?........................................................................................................................8B. Who can get services?.................................................................................................................................8C. How do I apply for services?.......................................................................................................................8

XV. PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY....................................................................8A. What services are provided?........................................................................................................................9B. Who can get services?.................................................................................................................................9C. Availability..................................................................................................................................................9D. How do I apply for services?.......................................................................................................................9

XVI. ADULT FOSTER CARE....................................................................................................................................9A. What services are provided?........................................................................................................................9B. Who can get services?.................................................................................................................................9C. How do I apply for services?.......................................................................................................................9

XVII. DAY ACTIVITY AND HEALTH SERVICES..................................................................................................9A. What services are provided?........................................................................................................................9B. Who can get services?.................................................................................................................................9C. How do I apply for services?.....................................................................................................................10

XVIII. PRE-ADMISSION SCREENING AND RESIDENT REVIEW (PASRR)......................................................10A. What services are provided?......................................................................................................................10

XIX. AREA AGENCIES ON AGING.......................................................................................................................10A. What services are provided?......................................................................................................................10B. Who can get services?...............................................................................................................................10C. How do I apply for services?.....................................................................................................................10

XX. AREA AGENCIES ON AGING TRANSPORTATION..................................................................................10A. Assisted Transportation.............................................................................................................................10B. Transportation...........................................................................................................................................10C. How do I apply for services?.....................................................................................................................10

POWERPOINT PRESENTATION................................................................................................................................11

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TEXAS HOME AND COMMUNITY- BASED SUPPORTS AND SERVICES

I. COMMUNITY LIVING AND ASSISTANCE AND SUPPORT SERVICES (CLASS)CLASS provides home- and community-based

services to people with related conditions as a cost- effective alternative to placement in an intermediate care facility for individuals with an intellectual disability or a related condition (ICF/IID). A related condition is a disability, other than an intellectual disability, that originated before age 22 and that affects a person’s ability to function in daily life.

Note: This service may not be available right away. Your name may be placed on an interest list. You will be contacted when services are available. If you are a current nursing facility resident and want to transition to the community using CLASS services, you will not have to be placed on an interest list.

A. What services are available?

Adaptive aids and medical supplies Behavioral support services Case management Cognitive rehabilitative therapy Continued Family Services Dental and dental sedation Employment assistance Habilitation Minor home modifications Nursing Occupational therapy Physical therapy Pre-vocational habilitation Respite care Specialized therapies (auditory enhancement/auditory integration

training, dietary, therapeutic horseback riding, and massage, recreational, music, aquatic and hippo therapies)

Speech and language pathology Supported employment Support Family Services Transition Assistance Services

In the CLASS program, the Consumer Directed Services (CDS) option is available to individuals who choose to self-direct one or more of the following program services:

Habilitation Cognitive rehabilitative therapy Employment assistance Nursing services Occupational therapy

Physical therapy Respite care Speech and language pathology Support consultation Supported employment Transition Assistance Services

When individuals select the CDS option, they are required to use Financial Management Services (FMS) and may access support consultation at https://hhs.texas.gov/laws- regulations/handbooks/community-living-assistance- support-services-provider-manual/class-pm-section- 4000-consumer-directed-services-cds

B. Who can get services?

You must be diagnosed with a related condition that manifested before age 22.

You must be eligible for Medicaid in the community and not be enrolled in another Medicaid waiver program.

You must meet level of care criteria for placement in an ICF/IID.

You must need habilitation and case management services.

You must live in your own or your family's home. Your income and resources may not exceed

specified limits. You cannot be enrolled in another waiver

program.

C. How do I apply for services?Call toll-free to 1-877-438-5658. Please be

prepared to provide Social Security and Medicaid numbers, type of disability, age of the onset of the disability, date of birth, address and telephone number of the person needing services.

II. HOME AND COMMUNITY-BASED SERVICES (HCS)Note: This service may not be available right

away. Your name may be placed on an interest list. You will be contacted when services are available. Certain individuals transitioning from or at risk of entering an institution may qualify for transition or diversion services without waiting.

The Home and Community-based Services (HCS) program provides individualized services and supports to people with intellectual disabilities who are living with their families, in their own homes or in other community settings, such as small group homes where no more than four people live. The local authority provides service coordination.


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A. What services are provided?

Adaptive aids Audiology Behavioral support services Cognitive rehabilitation therapy Day habilitation Dietary Dental treatment Employment assistance Minor home modifications Nursing Occupational therapy Physical therapy Residential assistance Respite Speech and language pathology Supported employment Transition Assistance Service

In the HCS program, the Consumer Directed Services (CDS) option is available only to those who live in their own home or family home. Individuals who receive foster/companion care, Residential Support or Supervised Living are not eligible to use the CDS option.

The HCS services currently available for self- direction are:

Supported Home Living (SHL) Employment Assistance Nursing Supported Employment Cognitive Rehabilitation Therapy Respite

When individuals select the CDS option, they are required to use Financial Management Services (FMS) and may access support consultation. https://hhs.texas.gov/laws- regulations/handbooks/home-community-based- services-handbook/hcs-section-13000-consumer- directed-services


You can of be any age. You must qualify for care in an intermediate care

facility for individuals with an intellectual disability or related conditions (ICF/IID).

You must have:

o a determination of an intellectual disability in accordance with state law,

o have a diagnosis of a related condition with an IQ of 75 or below, or

o be an individual with a related condition who meets medical necessity for a nursing facility level of care, have a moderate to extreme deficit in adaptive behavior, and may or may not have an intellectual disability.

You cannot be enrolled in another waiver program.

Your income and resources may not exceed specified limits.

C. How do I apply for services?Contact your Local Intellectual and

Developmental Disabilities Authority (LIDDA) https://hhs.texas.gov/doing-business-hhs/provider- portals/long-term-care-providers/local-intellectual- developmental-disability-authority-lidda/local- authorities-directory

III. TEXAS HOME LIVINGThe Texas Home Living (TxHmL) program

provides selected essential services and supports to people with an intellectual disability or a related condition who live in their own home or their family's home.

A. What services are available?

Adaptive aids Audiology Behavioral support serivces Community support services Day habilitation Dental treatment Dietary Employment assistance Minor home modifications Nursing Occupational therapy Physical therapy Respite Speech and language pathology Supported employment

In the TxHmL program, the Consumer Directed Services (CDS) option is available for all services.


There is no age limit. You must be determined eligible for Medicaid

services before enrolling in the program. You must meet specified functional criteria,

including having a determination of an intellectual disability made in accordance with state law or


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having been diagnosed by a physician as having a related condition with an IQ of 75 or below.

You must live in your own home or your family's home.

You cannot be enrolled in another Medicaid waiver program.


C. How do I apply for services?Contact your Local Intellectual and

Developmental Disabilities Authority (LIDDA) https://hhs.texas.gov/doing-business-hhs/provider- portals/long-term-care-providers/local-intellectual- developmental-disability-authority-lidda/local- authorities-directory

IV. DEAF BLIND WITH MULTIPLE DISABILITIES (DBMD)Note: This service may not be available right

away. Your name may be placed on an interest list. You will be contacted when services are available. If you are a Texas nursing facility resident you may qualify with our being on an interest list.

The Deaf Blind with Multiple Disabilities (DBMD) program provides home and community- based services to people who are deaf blind and have another disability. This is a cost-effective alternative to an intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID). The DBMD program focuses on increasing opportunities for consumers to communicate and interact with their environment.


Adaptive aids and medical supplies Assisted living (licensed up to six beds) Audiology Behavior support services Case management Chore provider Day habilitation Dental treatment Dietary services Employment assistance Environmental accessibility Intervener Minor home modification Nursing services Occupational therapy Orientation and mobility Physical therapy Residential habilitation Respite Speech, hearing and language therapy

Support consultation Supported employment Transition assistance services

You can access the following services through the consumer-directed option:

Residential habilitation Employment assistance Intervener Respite Supported employment


You must have a diagnosis of deafblindness (or a related condition that will result in deafblindness) as well as another disability resulting in a demonstrated need for one or more service on a monthly basis.

Your related condition must have manifested before age 22.

You must meet level of care criteria for placement in an ICF/IID.



C. Where can I get services?The program is available statewide.

D. How do I apply for services?Call 1-877-438-5658 and ask for the DBMD

program. Please be prepared to provide the Social Security and Medicaid numbers, type of disability, age of the onset of the disability, date of birth, and address and telephone number of the person who needs services.

V. MEDICALLY DEPENDENT CHILDREN PROGRAM (MDCP)Note: This service may not be available right

away. Your name may be placed on an interest list. You will be contacted when services are available. If you are a nursing facility resident, you may qualify without going on an interest list. If you are medically fragile and qualify for a short term nursing facility stay, you may qualify without going on an interest list.

The Medically Dependent Children Program (MDCP) provides services to support families caring for children who are medically dependent and encourages the transition of children in nursing homes back to the community.


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Adaptive aids Employment assistance Flexible family support services —

individualized and disability-related services, including personal care supports for basic activities of daily living (ADL), instrumental ADL, skilled care and delegated care supports, to:

o assist a child to participate in child care;o assist a person to participate in post-

secondary education; oro increase a person's independence.

Minor home modifications Financial management services Respite Supported employment Transition assistance services

The MDCP services currently available for consumer- direction are:

Employment Assistance Flexible Family Support Supported Employment Respite

When individuals select the CDS option, they are required to use Financial Management Services (FMS) and may access support consultation.


You must be under 21. If under 18, you must live with an adult family member (such as a parent, guardian or sibling) or with a foster family that includes no more than four children unrelated to you.

You must be a U.S. citizen or an alien with approved status who lives in Texas.

You must meet Medicaid eligibility guidelines including:

o be a low-income family with children, as provided in §1931 of the Social Security Act;

o be receiving Supplemental Security Income;o be eligible for Medical Assistance Only; oro meet eligibility for all other mandatory and

optional Temporary Assistance for Needy Families criteria in the Texas Medicaid State Plan.

You must meet the medical necessity determination for nursing home care.


C. How do I apply for services?Call 1-877-438-5658 to get on the interest list.

VI. STAR+PLUS WAIVERSTAR+PLUS is a Texas Medicaid managed care

program for people who have disabilities or are age 65 or older. People in STAR+PLUS get Medicaid health- care and home and community based services and supports through a managed care organization’s health plan that they choose in their service deliver area.

Long-term services and support includes thingslike:

Help in your home with basic daily activities. Help in making changes to your home so you can

safely move around. Short-term care to provide a break for caregivers. Help with things that need to get done.

Another feature of STAR+PLUS is service coordination. A STAR+PLUS staff member works with the member, the member’s family and the member’s doctors and other providers to help the member get the medical and long-term services and support they need.

A. Who can get services?To get services through STAR+PLUS you must:

(1) be approved for Medicaid, (2) live in a STAR+PLUS service area, and (3) be one or more of the following:

Age 21 or older, getting Supplemental Security Income (SSI) benefits, and able to get Medicaid due to low income.

Not getting SSI and able to get STAR+PLUS Home and Community-Based Waiver Services.

Age 21 or older, getting Medicaid through what are called “Social Security Exclusion programs” and meet program rules for income and asset levels.

The following people can’t be in the STAR+PLUS Waiver program:

People who get other Medicaid 1915(c) waiver services.

Those who live in facilities for people with Intellectual Developmental Disabilities (IDD).

People who are not able to get full Medicaid benefits, such as Frail Elderly program members, Qualified Medicare Beneficiaries, Specified Low- Income Medicare Beneficiaries, Qualified


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Disabled Working Individuals and illegal immigrants.

People who aren’t able to get Medicaid. Children in state foster care.

Important notes for those covered by Medicare:

You can get STAR+PLUS even if you get Medicare.

If you are covered by both Medicare and Medicaid (also known as “dual eligible”) and you join STAR+PLUS, you will keep getting regular health-care services through your Medicare doctor. STAR+PLUS does not change the way you get Medicare services.

B. What services are provided?The following is an overview of the services

STAR+PLUS offers. Medicaid managed care plans must have a service coordinator visit with the member within 30 days of enrolling in the program. The coordinator must find out the member’s needs and develop a plan of care.

Long-term services and supports can include:

Day Activity and Health Services (DAHS) Primary Home Care (PHC)

Other services under the STAR+PLUS Home and Community-Based Services Waiver include:

Personal assistance services, including protective supervision

Adaptive aids Adult foster care Assisted living Cognitive Rehabilitation Therapy Dental Emergency Response Services Employment Assistance Home delivered meals Medical supplies Minor home modifications Nursing Respite Unlimited Prescriptions Professional Therapies (occupational, physical,

and speech-language) Transitional assistance services

The Star + Plus services currently available for consumer-direction are:

Employment Assistance Cognitive Rehabilitation Therapy Nursing

Personal Assistance Services Professional Therapies (occupational, speech,

physical therapy) Supported Employment Respite

C. How do I apply for services?Call 1-877-438-5658 and ask for the Star + Plus

Waiver program.

VII. COMMUNITY FIRST CHOICEA. What is Community First Choice?

Community First Choice (CFC) provides certain services and supports to individuals living in the community who are enrolled in the Medicaid program and meet CFC eligibility requirements. Services and supports may include:

activities of daily living (eating, toileting, and grooming), activities related to living independently in the community, and health- related tasks (personal assistance services);

acquisition, maintenance, and enhancement of skills necessary for the individuals to care for themselves and to live independently in the community (habilitation);

providing a backup system or ways to ensure continuity of services and supports (emergency response services); and

training people how to select, manage and dismiss their own attendants (support management).

In Texas, CFC may be available to people enrolled in Medicaid, including those served by:

1915 (c) waiver programs such as CLASS, TxHmL, DBMD, MDCP, HCS and Star+Plus;

Medicaid managed care; and personal care services for children.

Individuals may use the Consumer Directed Services (CDS) option for certain CFC services.

CFC as a state plan Medicaid service is available to individuals with a need for habilitation, personal assistance or emergency response services who receive services in the following HHS Medicaid waiver programs:

Community Living Assistance and Support Services (CLASS);

Deaf Blind with Multiple Disabilities (DBMD); Certain individuals in Star+Plus waiver, Home and Community-based Services (HCS);

and Texas Home Living (TxHmL).


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CFC is also available through managed care organizations for individuals who meet eligibility criteria. Information about https://hhs.texas.gov/services/health/medicaid- chip/programs/childrens-health-insurance-program- chip/chip-comparison-charts/community-first-choice

B. Who can get Community First Choice services?To be eligible for Community First Choice

services an individual must:

Be eligible for Medicaid. Need help with activities of daily living, such as

dressing, bathing and eating. Need an institutional level of care.

C. Community First Choice ServicesCommunity First Choice Services include:

Help with activities of daily living and health- related tasks through hands-on assistance, supervision or cueing.

Services to help the individual learn how to care for themselves.

Backup systems or ways to ensure continuity of services and supports.

Training on how to select, manage and dismiss attendants.

D. Texas began the Community First Choice program on June 1, 2015. This means:

Individuals on a 1915(c) waiver interest list who meet eligibility and coverage requirements may be eligible to get Community First Choice services.

Individuals already getting services through a 1915(c) waiver will continue to get those services as they do today from their existing providers.

VIII. COMMUNITY ATTENDANT SERVICESCommunity Attendant Services (CAS) is a non-

technical, non-skilled service providing in-home attendant services to people who need help with personal care tasks. CAS is available to eligible adults and children whose health problems cause them to be functionally limited in performing activities of daily living.


Escort: Accompanying a person to a medical appointment. This service does not include direct transportation by an attendant.

Home management: Help with housekeeping activities to support the person’s health and safety, including cleaning, laundry, shopping and other household tasks.

Personal care: Help with activities related to physical health, including bathing, dressing, grooming, routine hair and skin care, preparing meals, feeding, exercising, helping with self- administered medication, toileting, and transferring/ambulating.


You can be of any age. You must be functionally limited in performing at

least one personal care task, based on your medical condition.

You must have a practitioner’s statement of medical need.

You must have an unmet need for home management and personal care.


You must not be Medicaid eligible.

C. How do I apply for services?Contact your local Texas Health and Human

Services (HHS) office . 855.937.2372

IX. PRIMARY HOME CAREPrimary Home Care (PHC) provides non-

technical, non-skilled, in-home attendant services to people who have an approved medical need for assistance with personal care tasks. PHC is available to eligible people whose health problems cause them to be functionally limited in performing activities of daily living according to a practitioner's statement of medical need. Attendants provide PHC services.


Escorting a person to medical appointments for diagnosis and/or treatment.

Home management to help with housekeeping activities that support the person’s health and safety.

Personal care related to the care of the person’s physical health.


You must be 21 or older. You must have an unmet need for help with home

management and personal care tasks. You must have a practitioner’s statement of

medical need.


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You must be eligible for Medicaid. You must meet a specified functional assessment

score and have a functional limitation with at least one personal care task based on your medical condition.



X. CONSUMER MANAGED PERSONAL ATTENDANT SERVICESUnder the Consumer Managed Personal Attendant

Services (CMPAS) program, the Texas Health and Human Services Commission (HHSC) contracts with licensed agencies to provide personal assistance services to people with physical disabilities who are mentally and emotionally competent and willing to supervise their own attendant or who have someone who can supervise the attendant for them.

Licensed personal assistance services agencies determine eligibility and the amount of care needed, develop a pool of potential personal assistants, and provide emergency back-up personal assistants.


Health-related tasks prescribed by a physician. Personal assistance, as needed, by personal

attendants selected and supervised by the person getting services.


You must be 18 or older. You must need help with at least one personal

care task. You must be able to direct your own care. Your doctor must verify you have a current

medical need for help with personal care tasks and other activities of daily living.

You have a copay after $2,199.00 of income. There are no resource limits.

C. How do I apply for services?Contact your local Health and Human Services

(HHS) office . 855.937.2372

D. Where can I get services?Services are available in these counties.

Region 1: Lubbock, Potter and Randall Region 3: Collin, Dallas, Denton, Ellis, Hood,

Johnson, Kaufman, Parker, Rockwall, Tarrant and Wise

Region 5: Angelina, Hardin, Houston, Jasper, Jefferson, Nacogdoches, Newton, Orange, Polk, Sabine, San Augustine, San Jacinto, Shelby, Trinity and Tyler

Region 6: Fort Bend, Harris, Montgomery and Wharton

Region 7: Travis Region 8: Atascosa, Bexar, Comal, Guadalupe,

Kendall, Medina and Wilson Region 10: El Paso Region 11: Aransas, Bee, Brooks, Cameron,

Duval, Hidalgo, Jim Hogg, Jim Wells, Kenedy, Kleberg, Live Oak, McMullen, Nueces, Refugio San Patricio, Starr, Webb, Willacy and Zapata

XI. FAMILY CAREFamily Care is a nonskilled, nontechnical

attendant care service available to eligible adults who are functionally limited in performing activities of daily living. Services are provided by an attendant and do not require the supervision of a registered nurse.


Escort: Accompanying a person to a medical appointment. This service does not include direct transportation by an attendant.

Home management: Help with housekeeping activities to support the person’s health and safety, including cleaning, laundry, shopping and other household tasks.

Personal care: Help with activities related to physical health, including bathing, dressing, grooming, routine hair and skin care, preparing meals, feeding, exercising, helping with self- administered medication, toileting, and transferring/ambulating.


You must be 18 or older. You must have an unmet need for home

management and/or personal care tasks. Your income and resources may not exceed

specified limits. You must meet a specified functional assessment

score.




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XII. HOME-DELIVERED MEALSThe Home Delivered Meals program provides a

nutritious meal delivered to the person’s home to ensure he or she gets at least one healthy meal per day.

A. Who can get services?

You must be 18 or older. You must be functionally limited in preparing

meals. You must meet a specified functional

assessment score.

B. How do I apply for services?Contact your local Texas Health and Human


XIII. DAY ACTIVITY AND HEALTH SERVICES Licensed day activity and health services

(DAHS) facilities provide daytime services to people who live in the community as an alternative to living in a nursing home or other institution. Services, which usually are provided Monday through Friday, address physical, mental, medical and social needs. Sometimes,this is called adult day care or adult day services.


Noon meal and snacks Nursing and personal care Physical rehabilitation Social, educational and recreational activities Transportation


You must be at least 18. You must have a functional disability related to

medical diagnosis. You must have a medical diagnosis and

physician’s order requiring care or supervision. You must need help with one or more personal

care tasks. You must meet these eligibility criteria:

o you must be a Medicaid recipient to get Title XIX services; and

o your income and resources may not exceed specified limits to get Title XX services.



XIV. IN-HOME AND FAMILY SUPPORTThe In-Home and Family Support program

provides direct grant benefits to people with physical disabilities and/or their families to choose and purchase services that help them to remain living in their own homes.


Access to counseling and training programs to help people provide proper care to a person with a disability.

Attendant care, home health services, home health aide services, homemaker services, chore services to provide instruction/training and assistance with routine body functions, dressing, preparing and consuming food, and ambulating.

Medical, surgical, therapeutic, diagnostic and other health services related to a person's disability, which may include medications not covered by Medicare or Medicaid.

Other disability related services pre-approved by the Texas Department of Aging and Disability Services.

Pre-approved transportation as well as room and board cost incurred by a person with a physical disability or his or her family during evaluation or treatment.

Purchase or lease of special equipment or architectural modifications of a home to facilitate care, treatment therapy or general living conditions of a person with a disability.

Respite care.


You must be 4 or older. You must have a physical disability substantially

limiting one or more major life activities. A copayment begins at 105 percent of the state

median income for household size.



XV. PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLYThe Program of All-Inclusive Care for the

Elderly (PACE) provides community-based services to people who are frail and elderly who qualify for nursing home placement. PACE uses a comprehensive care approach, providing an array of services that costs less than comparable nursing home care.


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A. What services are provided?All necessary health-related services, including

in-patient and outpatient medical care, specialty services like dentistry and podiatry, social services, in- home care, meals, transportation and day activity.


You must be 55 or older. You must qualify for a nursing facility level of

care. Your income and resources may not exceed

specified limits.

C. AvailabilityPACE is available only in the ZIP Codes listed

below.

Amarillo/Canyon: 79015, 79101, 79102,79103, 79104, 79106, 79107, 79108, 79109,79110, 79111, 79118, 79119, 79121 and 79124

El Paso: 79901, 79902, 79903, 79904, 79905,79907, 79915, 79924, 79925, 79930, 79935§and 79936

Lubbock: 79401, 79402, 79403, 79404, 79405,79406, 79407, 79408, 79409,79410, 79411,79412, 79413, 79414, 79415, 79416, 79423,79424, 79430, 79452, 79453, 79454, 79464,79490, 79491, 79493 and 79499

D. How do I apply for services?Contact the local PACE organization:

If you live in El Paso, call: Bienvivir All- Inclusive Senior Health at 1-915-562-3444.

If you live in Amarillo, call: The Basics at Jan Werner at 1-806-374-5516.

If you live in Lubbock, call: Silver Star Health Network at 1-806-740-1500.

XVI. ADULT FOSTER CAREAdult Foster Care (AFC) provides a supervised,

24-hour living arrangement in an adult foster home for people who are unable to continue living independently in their own homes because of a physical, mental or emotional limitation.

AFC providers and residents live in the same household and share a common living area. With the exception of family members, no more than three adults may live in the foster home unless the home is licensed as a Type C Assisted Living Facility or as a Type A Small Group Home. The person receiving services pays the provider for room and board.


Help with personal care tasks Help with activities of daily living Help preparing meals Help providing or arranging for transportation


You must be 18 or older. You must meet a specified functional

assessment score. You may be a Medicaid recipient or have

resources not exceeding specified limits.



XVII. DAY ACTIVITY AND HEALTH SERVICESLicensed day activity and health services

(DAHS) facilities provide daytime services to people who live in the community as an alternative to living in a nursing home or other institution. Services, which usually are provided Monday through Friday, address physical, mental, medical and social needs. Sometimes, this is called adult day care or adult day services.


Noon meal and snacks Nursing and personal care Physical rehabilitation Social, educational and recreational activities Transportation


You must be at least 18. You must have a functional disability related

to medical diagnosis. You must have a medical diagnosis and

physician’s order requiring care or supervision. You must need help with one or more personal

care tasks. You must meet these eligibility criteria:

o you must be a Medicaid recipient to get Title XIX services; and

o your income and resources may not exceed specified limits to get Title XX services.


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C. How do I apply for services?Contact your local Health and Human Services

(HHS) office . 855.937.2372

XVIII. PRE-ADMISSION SCREENING AND RESIDENT REVIEW (PASRR)All people who are planning to move to a

partially federally funded nursing facility and who are suspected of having a mental illness, or a diagnosis of an intellectual disability or a related condition must receive a Pre-admission Screening and Resident Review (PASSR) screening. This includes private pay individuals.

People are assessed to see if they need specialized services. People who are not satisfied with their PASRR determination have the right to a fair hearing to appeal the determination.


Alternate placement services Customized manual wheelchairs and

specialized durable medical equipment Determination of intellectual disability Rehabilitative/maintenance therapies Service coordination by the local authority or

local mental health authority Vocational training

XIX. AREA AGENCIES ON AGINGThe 28 local area agencies on aging (AAA)

contract with the Texas Health and Human Services (HHC) to help people 60 and older and their caregivers find the information they need to locate and access community services.


Benefits counseling/legal assistance Care coordination Information, referral and assistance Legal awareness Ombudsman Program

B. Who can get services?You must be 60 or older, with priority for

services given to:

People with low incomes People who live in rural areas People with limited English proficiency People with Alzheimer’s disease and related

disorders People at risk of being placed in a long-term

care facility

Family members and/or other caregivers who are younger than 60 may receive support services on behalf of the person for whom they provide care.

C. How do I apply for services?Contact your AAA by calling 855 937 2372

XX. AREA AGENCIES ON AGING TRANSPORTATION

A. Assisted TransportationAssistance and transportation, including escort, is

provided to people who are older and have difficulty, whether physical or cognitive, using regular transportation. Each “trip” includes the following:

Helping prepare for the trip Helping the person get in the vehicle at his or her

home and out of the vehicle at the destination (such as a medical office)

Staying with the person at their destination

B. TransportationThis service involves taking a person who is older

from one location to another, but does not include any other activity. There are two types of transportation services:

Demand/Response takes people from a specific origin to a specific destination upon request. People usually have to request this service 24-48 hours before the planned trip.

Fixed route transportation operates in a predetermined route with permanent transit stops, which are clearly marked with route numbers and departure schedules. The person who is older does not reserve a ride; he or she simply goes to the designated location at the designated time.

C. How do I apply for services?Contact your AAA by calling. 855 937 2372

SUPPORTS & SERVICES – ALTERNATIVES TOGUARDIANSHIP

Richard LaValloLegal Director Disability Rights Texas


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GUARDIANSHIP REFORMS

The legislature mandated that a probate court must consider alternatives to guardianship and supports and services before a guardianship is created.

LEAST RESTRICTIVE ALTERNATIVES POLICIES


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GUARDIANSHIP POLICYTexas courts have the authority to appoint a guardian with full or limited authority over an incapacitated person. However, a guardianship should be only as restrictive:as indicated by the person’s actual mental or physical limitations; and

as necessary to promote and protect his or her well-being.Tex. Est. Code § 1001.001(a).

Supports and Services No GuardianshipSupports

and Services

&

Full Guardianship

THE CONTINUUMSupports and Services

No Guardianship “Supports and Services &

Limited Guardianship

Full Guardianship

. . . the court shall design theguardianship to encourage the development or maintenance of maximum self-reliance and independence in the incapacitated person, including by presuming that the incapacitated person retains capacity to make personal decisions regarding the

person’s residence. ”TEX. ESTATES CODE § 1001.001(b)


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GUARDIANSHIP POLICY (CONT.)

When an application for guardianship is filed, a court investigator must determine whether a less restrictive alternative to guardianship is appropriate.Tex. Est. Code § 1054.151.

NEW: All parties – the applicant, attorney ad litem, guardian ad litem, physicians, and the court have an obligation to consider less restrictive alternatives and

SUPPORTS AND SERVICESINFORMALFamilyFriends

FORMALAlternatives to GuardianshipMedicaid and General Revenue servicesSupported Decision-Making

OTHERFree or Reduced MealsPrescription DeliveryFree or Reduced TransportationDirect Deposits & PaymentsJoint Accounts and Debit CardsDaily Call or Home Visit ServicesTechnology


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SUPPORTS AND SERVICES

Available formal and informal resources and assistance that enable an individual to:1. Meet the individual’s needs for food,

clothing or shelter;2. Care for the individual’s physical or mental

health;3. Manage the individual’s financial affairs; or4. Make personal decisions regarding


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SUPPORTS & SERVICES THROUGH MEDICAID

•Medicaid Entitlement Long Term Services and Supports provided by HHSC• https://hhs.texas.gov/long-term-care-programs- services

•Medicaid Waiver Home and Community Based Programs provided by HHSC

SUPPORTS & SERVICES THROUGH MEDICAID

•Medicare Home Health Care• http://www.medicareinteractive.org/get- answers/medicare-covered-services/home-health-care- benefits-part-a-an-b/types-of-home-health-care-that- medicare-will-pay-for

SUPPORTS AND SERVICESEndless Combinations and Possibilities


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WHERE TO CALL TO GET HHS LONG-TERM

CARE SERVICES?To obtain information about long-term care for older adults or persons with disabilities, call 1- 855-937-2372.

http://www.dads.state.tx.us/services/contact.cfm

SUPPORTS AND SERVICESAll parties must now consider whether supports and services would avoid the need for guardianship.Applicants § 1101.001(3-a), (3-b)Guardians Ad Litem § 1054.054(c)(2)Attorneys Ad Litem § 1054.004(a)(4)Court Investigators § 1054.151Courts § 1101.101(a)(1)(E), (c)(2)Physicians § 1101.103(b)(4)(E), (b)(6), (b)(6-a)


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MEDICAL EXAMNEW: The letter or certificate from a physician supporting an application for guardianship must state:1. Whether the proposed ward would benefit

from supports and services that would allow the individual to live in the least restrictive environment; Tex. Est. Code § 1101.103(b)(6) and

2. Whether guardianship is necessary and, if so, what powers or duties of the guardian should be limited if the


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USING SUPPORTS

AND SERVICES TO LIMIT OR END

GUARDIANSHIPS

INITIALGUARDIANSHIPS


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BEFORE APPOINTING A GUARDIAN: EVIDENCE REQUIREDBefore appointing a guardian, the probate court must find by clear and convincing evidence that alternatives to guardianship and supports and services have been considered and determined not to be feasible.If the court grants a limited guardianship, the court must specifically state whether the proposed ward lacks

RESTORATION OF CAPACITY


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THE ROLE OF SUPPORTS AND SERVICESNEW: A guardianship shall be closed when the court finds that the ward has sufficient capacity with supports and services to care for himself or herself and to manage his or her property. Tex. Est. Code § 1202.001(b)(2).

NEW: A ward or any interested person may petition the court for the full or partial restoration of rights, including the right to decide their residence if he or she has sufficient capacity with or without

THE ROLE OF SUPPORTS AND SERVICES (CONT.)

• NEW: The court shall consider whether the guardianship is needed and specific power or duties of the guardian should be limited if the ward receives supports and services. Tex. Est. Code § 1202.151(a).

• NEW: The court order must state any supports and services needed for the restoration or modification of the guardianship. Tex. Est. Code § 1202.154(a)(4).


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REQUIRED FINDINGSBefore ordering the settlement and closing of the guardianship, the court must find that the person is no longer partially or fully incapacitated.Before granting additional powers or duties to the guardian, the court must find that the current nature and degree of incapacity warrants modification and that some or all rights need to be further restricted.NEW: Before limiting the powers or duties granted to the guardian, the court must find that the nature and degree of incapacity, with or without supports and services, warrants modification and that some of the individual’s rights need to be restored, with or without supports and services.

Tex. Est. Code § 1202.153.

TRANSITION TO A SUPPORTED

DECISION-MAKING AGREEMENT

SUPPORTEDDECISION-MAKING

“. . . guardianship is no longer warranted becausethere is now a system of supported decision-making in place that constitutes a less restrictive alternate to the Draconian loss of liberty entailed by a plenary. . . guardianship. This use of supported decision-making, rather than a guardian's substituted decision-making, is also consistent with international human rights.

In re the Guardianship of Dameris 956 N.Y.S.2d 848, 853 (2009).”


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WHAT IS SUPPORTED DECISION-MAKING?

“A process of supporting and accommodating an adult with a disability to enable the adult to make life decisions, including decisions related to where the adult wants to live, the services, supports, and medical care the adult wants to receive, whom the adult wants to live with, and where the adult


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SUPPORTED DECISION-MAKING AND RESTORATION

NEW: Persons under guardianship can petition the court to retain counsel of their choosing to assist with restoration or transitioning to a supported decision-making agreement. Tex. Est. Code§ 1151.351(b)(17).

Limitation: the individual must retain the right to contract. Tex. Est.

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